CMS Eases MACRA Pain for Doctors

Four options offered for participation next year

WASHINGTON -- Responding to complaints from Congress and organized medicine, the Centers for Medicare & Medicaid (CMS) announced Thursday that it will give physicians several options to comply with Medicare payment rules set to go into effect next year.

"In recognition of the wide diversity of physician practices, we intend for the Quality Payment Program to allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017," CMS acting administrator Andy Slavitt wrote in a blog post. "During 2017, eligible physicians and other clinicians will have multiple options for participation. Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019."

Under the Medicare Access and CHIP Reauthorization Act (MACRA) -- the bill that repealed the sustainable growth rate formula for physician reimbursement under Medicare -- physicians must choose from one of two paths beginning next year: they can either participate in an alternative payment model such as an accountable care organization, or they can join in the Merit-Based Incentive Payment System (MIPS), which requires doctors to submit quality reporting data to Medicare.

Slavitt outlined four options for physicians:

Test the Quality Payment Program. "With this option, as long as you submit some data to the Quality Payment Program, including data from after January 1, 2017, you will avoid a negative payment adjustment," he wrote. "This first option is designed to ensure that your system is working and that you are prepared for broader participation in 2018 and 2019 as you learn more."

Participate for part of the calendar year. Under this option, physicians could submit quality information "for a reduced number of days," Slavitt explained. "This means your first performance period could begin later than January 1, 2017 and your practice could still qualify for a small positive payment adjustment. ... You could select from the list of quality measures and improvement activities available under the Quality Payment Program."

Participate for the full calendar year. Practices that are ready to start on Jan. 1 could submit quality information for a full year, and thus could qualify for a "modest" payment adjustment, he said. "We've seen physician practices of all sizes successfully submit a full year's quality data, and expect many will be ready to do so."

Participate in an Advanced Alternative Payment Model in 2017. Practices that choose not to report quality data could instead join an advanced alternative payment model, such as a Medicare Shared Savings program, in 2017. "If you receive enough of your Medicare payments or see enough of your Medicare patients through the advanced alternative payment model in 2017, then you would qualify for a 5% incentive payment in 2019," Slavitt noted.

More details on these options will become available when CMS releases its final rule for implementing the Quality Payment Program, sometime before Nov. 1, Slavitt noted. "We appreciate the sincere and constructive participation in the feedback process to date and look forward to advancing step by step in that same spirit."

Reactions to Slavitt's announcement were swift. "The AMA strongly applauds [Health and Human Services] Secretary [Sylvia] Burwell and Acting Administrator Slavitt – and their teams – for listening to physicians' concerns about the timeline that was originally proposed for MACRA," AMA president Andrew Gurman, MD, said in a statement. "By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA. This approach better reflects the diversity of medical practices throughout the country."

Rep. Michael Burgess, MD (R-Texas), an ob/gyn and member of the House Energy & Commerce Health Subcommittee, also hailed the announcement. "Today's announcement from CMS regarding the agency's dedication to flexibility in the implementation of MACRA is proof of the benefits of keeping Congress involved in policy implementation," he said in a statement. "Just as this policy was carefully crafted with the input of everyone affected by the payment policies, the implementation process should be conducted in the same way. I am committed to leading the charge for continued Congressional oversight of MACRA implementation to ensure simplified, streamlined requirements that allow for all doctors to succeed."

Slavitt hinted at a Senate hearing in July that CMS might be open to delaying parts of the law. "We remain open to multiple approaches," he said. "Some things on the table include alternative start dates, looking at whether shorter [reporting] periods could be used, and finding other ways for physicians [to get used to] the program before the impact really hits them."